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Randomized Controlled Trial
. 2020 Feb 1;180(2):206-214.
doi: 10.1001/jamainternmed.2019.5176.

Effectiveness of a Brief Self-determination Theory-Based Smoking Cessation Intervention for Smokers at Emergency Departments in Hong Kong: A Randomized Clinical Trial

William Ho Cheung Li  1 , Ka Yan Ho  2 , Man Ping Wang  1 , Derek Yee Tak Cheung  1 , Katherine Ka Wai Lam  2 , Wei Xia  1 , Kai Yeung Cheung  3 , Carlos King Ho Wong  4 , Sophia Siu Chee Chan  1 , Tai Hing Lam  5
Affiliations
Randomized Controlled Trial

Effectiveness of a Brief Self-determination Theory-Based Smoking Cessation Intervention for Smokers at Emergency Departments in Hong Kong: A Randomized Clinical Trial

William Ho Cheung Li et al. JAMA Intern Med. .

Abstract

Importance: Clinicians have an opportunity to provide smoking cessation interventions to smokers who present to emergency departments (EDs). The effectiveness of a brief intervention based on self-determination theory for smoking cessation is uncertain.

Objective: To examine the effectiveness of a brief intervention based on self-determination theory for smoking cessation (immediate or progressive) among Chinese smokers presenting at EDs in Hong Kong.

Design, setting, and participants: This single-blind, multicenter intent-to-treat randomized clinical trial was conducted at the EDs of 4 major acute care hospitals in different districts of Hong Kong. In total, 1571 smokers 18 years or older who presented at 4 major EDs between July 4, 2015, and March 17, 2017, were randomized into an intervention group (n = 787) and a control group (n = 784).

Interventions: The intervention group received brief advice (about 1 minute) and could choose their own quit schedules (immediate or progressive). The control group received a smoking cessation leaflet.

Main outcomes and measures: Follow-up visits were conducted at 1, 3, 6, and 12 months. The primary outcome measure, by intent to treat, was biochemically validated abstinence at 6 months.

Results: Participants (N = 1571) included 1381 men (87.9%); the mean (SD) age at baseline was 47.4 (16.4) years. Among participants who self-reported abstinence at 6 months, 50.3% (85 of 169) had biochemical validation by both an exhaled carbon monoxide test and a saliva cotinine test. Compared with the control group, the intervention group had statistically higher biochemically validated abstinence at 6 months: 6.7% (53 of 787) vs 2.8% (22 of 784) (P < .001), with an adjusted relative risk of 3.21 (95% CI, 1.74-5.93; P < .001). The intervention group also had higher self-reported quit rates at 6 months (12.2% [96 of 787] vs 9.3% [73 of 784], P = .04) and 12 months (13.0% [102 of 787] vs 8.5% [67 of 784], P < .01), as well as higher biochemically validated abstinence at 12 months (7.0% [55 of 787] vs 3.7% [29 of 784], P < .001). The additional cost for each intervention group participant was US $0.47, with an estimated gain of 0.0238 quality-adjusted life-year. The incremental cost per quality-adjusted life-year (US $19.53) fell within acceptable thresholds.

Conclusions and relevance: This brief, low-cost self-determination theory-based intervention for smokers presenting at EDs effectively increased the biochemically validated quit rate at 6 months. If delivered routinely, such a simple intervention may offer a cost-effective and sustainable approach to help many smokers quit smoking.

Trial registration: ClinicalTrials.gov identifier: NCT02660957.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Wong reported receiving grants from the Hong Kong Health and Medical Research Fund Research Fellowship Scheme, the General Research Fund of the Hong Kong Research Grant Council, and the EuroQol Research Foundation. Dr T.H. Lam reported receiving grants from the Food and Health Bureau of the Government of the Hong Kong Special Administrative Region. No other disclosures were reported.

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Figure.. CONSORT Flow Diagram
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References

    1. Rabe GL, Wellmann J, Bagos P, et al. . Efficacy of emergency department–initiated tobacco control: systematic review and meta-analysis of randomized controlled trials. Nicotine Tob Res. 2013;15(3):643-655. doi:10.1093/ntr/nts212 - DOI - PubMed
    1. Lam TH, Chan SS, Abdullah AS, Wong VT, Chan AY, Hedley AJ. Smoking reduction intervention for smokers not willing to quit smoking: a randomised controlled trial. Hong Kong Med J. 2012;18(suppl 3):4-8. - PubMed
    1. Wang MP, Li WHC, Cheung YT, et al. . Brief advice on smoking reduction versus abrupt quitting for smoking cessation in Chinese smokers: a cluster randomized controlled trial. Nicotine Tob Res. 2017;20(1):67-72. doi:10.1093/ntr/ntx026 - DOI - PubMed
    1. Ho KY, Li WHC, Wang MP, Lam KKW, Lam TH, Chan SSC. Comparison of two approaches in achieving smoking abstinence among patients in an outpatient clinic: a phase 2 randomized controlled trial. Patient Educ Couns. 2018;101(5):885-893. doi:10.1016/j.pec.2018.02.003 - DOI - PubMed
    1. Deci E, Ryan R. Handbook of Self-determination Research. Rochester, NY: University of Rochester Press; 2002.

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